The hystero trainer, a simulator for diagnostic and operative hysteroscopy

doi:10.1016/S1074-3804(05)80833-3

The Journal of the American Association of Gynecologic Laparoscopists

Volume 2, Issue 1, November 1994, Pages 61-63

https://doi.org/10.1016/S1074-3804(05)80833-3 Get rights and content

Abstract

Hysteroscopy has become an integral part of operative gynecology, with rates of major complications of 1%. To avoid serious, even lethal, complications, an intensive, well-structured training program for practicing surgeons is necessary. In response to these educational requirements, the Hystero Trainer was developed to provide in vitro simulation training for diagnostic and operative hysteroscopy, including laser and high-frequency electrosurgery.

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Cited by (19)

Essentials in Minimally Invasive Gynecology Manual Skills Pilot Validation Trial: EMIG Manual Skills Pilot Study
2020, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Although hysteroscopy is an extremely important aspect of MIGS, there is no such component in the FLS system. Although first published in the mid-1990s [9–11], there are still relatively few hysteroscopic simulation studies available in the literature, with a limited number evaluating construct validity [12–14] with variable quality and none to date demonstrating predictive validity [15,16]. The EMIG Hysteroscopy Simulation System may provide an opportunity to expand this critically important aspect of simulation science for the gynecologic community.
To evaluate the Essentials in Minimally Invasive Gynecology (EMIG)- Fundamentals of Laparoscopic Surgery Laparoscopic Simulation System and the EMIG Hysteroscopy Simulation System for face validity and functionality in a pilot testing environment.
A prospective controlled pilot study.
Three teaching institutions in the US Southwest.
Twenty-seven residents and gynecologists, with 22 fitting who fit 1 of 4 categories of exposure to hysteroscopic and laparoscopic surgery and surgical simulation. Eleven were postgraduate year 1 and 5 postgraduate year 3, 1 was American Board of Obstetrics & Gynecology certified, and 5 were either fellows in-training or had completed a fellowship in minimally invasive gynecologic surgery.
After completing a screening survey, each subject was exposed to a structured orientation to the 2 simulation systems and then tested with proctor supervision on the 5 laparoscopic and 2 hysteroscopic exercises. A short 5-point Likert questionnaire designed to determine face validation and question clarity was administered to each subject at sites 2 and 3.
Face validity was high for each of the 7 exercises (means ranged from 4.8 to 4.9 of 5), and subjects considered instructions to be clear (means from 4.7 to 4.9). The recorded exercise times generally reduced with increasing levels of training, although the sample sizes were not designed to determine significance given the pilot design. Similarly, exercise errors were generally less frequent with increasing experience. The systems, including the devices and recording mechanisms, performed well, and proctor evaluation and training were satisfactory.
The EMIG laparoscopic and hysteroscopic simulations systems were considered to have good face validity and appear to be suitable for a construct validation trial to confirm their utility in distinguishing among trainees and practitioners with a wide spectrum of endoscopic surgical experience. The recording and specimen storage mechanisms will allow for multiple proctors to rate a candidate's performance, thereby enhancing evaluation consistency and quality.
Training and Assessment of Hysteroscopic Skills: A Systematic Review
2016, Journal of Surgical Education
Citation Excerpt :
Eligibility was assessed for 42 records, including 7 conference papers for which full-text versions could not be retrieved. A total of 18 full-text articles were excluded.9,38-54 Overall, 2 additional articles were identified by manual screening of references and search for citations.55,56
The aim of this systematic review was to identify studies on hysteroscopic training and assessment.
PubMed, Excerpta Medica, the Cochrane Library, and Web of Science were searched in January 2015. Manual screening of references and citation tracking were also performed. Studies on hysteroscopic educational interventions were selected without restrictions on study design, populations, language, or publication year. A qualitative data synthesis including the setting, study participants, training model, training characteristics, hysteroscopic skills, assessment parameters, and study outcomes was performed by 2 authors working independently. Effect sizes were calculated when possible. Overall, 2 raters independently evaluated sources of validity evidence supporting the outcomes of the hysteroscopy assessment tools.
A total of 25 studies on hysteroscopy training were identified, of which 23 were performed in simulated settings. Overall, 10 studies used virtual-reality simulators and reported effect sizes for technical skills ranging from 0.31 to 2.65; 12 used inanimate models and reported effect sizes for technical skills ranging from 0.35 to 3.19. One study involved live animal models; 2 studies were performed in clinical settings. The validity evidence supporting the assessment tools used was low. Consensus between the 2 raters on the reported validity evidence was high (94%).
This systematic review demonstrated large variations in the effect of different tools for hysteroscopy training. The validity evidence supporting the assessment of hysteroscopic skills was limited.
Simulation training in echocardiography: The evolution of metrics
2013, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
While standardized patients and clinical scenarios had long been used as teaching aids in medical education, simulation as a task training tool was not introduced until much later.17 Eventually, task training simulation systems were adopted by numerous clinical disciplines (Table 1).16,18–26 But the advent of minimally invasive surgery necessitated the development of task training simulation paradigms to facilitate acquisition of complex fine motor skills in a controlled simulated environment.
Surgical Simulation: Where Have We Come From? Where Are We Now? Where Are We Going?
2012, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Remember, only 27 hysteroscopic simulation articles were identified in the literature search. The first references to hysteroscopic simulation were published in 1994 [45,46], and the initial description of a virtual reality system in 1996 [47]. A particular issue in hysteroscopy is that the spectrum of required skills is not as amenable to simulation in the context of inorganic box type simulators, and no live animal model has even face validity.
It is now clear to most stakeholders that acquisition of surgical psychomotor skills is best achieved outside of the clinical operating room, in the context of a simulated environment. Endoscopic simulation can be accomplished using simple “box” simulators or video trainers, and virtual reality simulation is now possible using microprocessor-controlled systems. Structured surgical training performed outside of the operating room environment is relatively new to health care, a circumstance different from the process of pilot training, in which simulation has been a mainstay for more than 75 years and in which virtual reality simulation is now the norm. Those charged with surgical education are faced with a dilemma as, while attempting to understand the basic goals of simulation, they are simultaneously faced with choice between relatively inexpensive video trainers and the often prohibitively expensive virtual reality systems. This article explores the history of simulation, reports the results of a modified systematic review of currently available systems and performance, and identifies the gaps in current research and development. It is apparent that available video trainers provide the opportunity for skill development that at present is not surpassed by virtual reality systems. In the future, there will likely be an increasing role for virtual reality; however, challenges remain that include determination of the appropriate metrics and system design, and the fiscal resources necessary for the required hardware and related software development.
Training, assessment and competency in gynaecologic surgery
2006, Best Practice and Research: Clinical Obstetrics and Gynaecology
The trainee gynaecologist requires specific teaching to achieve competency in gynaecological surgery. Basic skills such as knot tying and suturing should be acquired outside the operating theatre. They can be learned on simulations, including bench models, using synthetic materials, life-like models and animal tissue. Video training equipment is useful for the development of basic laparoscopic hand–eye coordination. Intermediate and advanced skills require simulations using more sophisticated bench models, live animals and virtual reality computerised systems. Structured teaching and assessment methods are essential. Surgical skills training models should be reliable and valid, and can be incorporated into an objective structured clinical examination, which could be used to assess individual development and allow progression through a training programme. Simulation training does translate into improved operative performance. Supervised operating experience on patients is crucial to training and should be assessed regularly using a global rating form with constructive feedback to facilitate improvement.
A new curriculum for hysteroscopy training as demonstrated by an objective structured assessment of technical skills (OSATS)
2005, American Journal of Obstetrics and Gynecology
The purpose of this study was to develop an effective curriculum to teach hysteroscopy, as well as to develop an objective assessment instrument (OSATS).
All 24 residents in our training program attended a 3-hour hysteroscopy curriculum in each of 3 years. Each year after the curriculum, an OSATS was administered consisting of an assembly and operative task. Each task was evaluated with a task-specific checklist and a previously validated global assessment form. Twenty-four residents from an outside institution served as controls. All residents were examined by blinded and unblinded examiners.
The reliability coefficient was .7857 for the checklist and .9763 for the global scale. Interrater reliability for the checklist was .7478 and ranged from .4222 to .9329 for the global instruments. Evaluation of construct validity revealed that the junior residents at both locations did significantly worse on the checklist and global scale than the senior residents for all 3 years of the study (P < .001). Those residents provided the curriculum did significantly better on both the checklist and the global scale than the resident controls with a mean of 45% versus 63% for the checklist and 18.3 versus 24.9 for the global score. (P = .001 checklist, P = .007 global scale).
This curriculum is an effective way to impart knowledge and skill in the assembly and use of the operative hysteroscope. The checklist developed for this OSATS has excellent reliability and construct validity.

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¹: Schuran Company, Jülich, Germany

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The hystero trainer, a simulator for diagnostic and operative hysteroscopy

Abstract

Fertil Steril

American Association of Gynecologic Laparoscopists' 1988 membership survey on operative hysteroscopy

Zentralbl Gynäkol